Oral Abstract

Presentation
Holly Milby
About the Patient

Medical History:

● Taking 11 different medications to help nerve pain, high blood pressure and type 2 diabetes
● Blood pressure the day of the appointment was: 132/80
● Type II diabetes is uncontrolled and last A1c reading was 9
● Patient explained on their medical history they wanted to start a new healthy diet
Patients Dental History

● Currently brushing twice daily and using interdental brushes where she has food impaction
● Date of last x-rays previous to visit: 6+ years
● Date of last cleaning: 6+ years
● No concerns about her periodontal diagnosis
● Always had “regular cleanings” in the past
Recommendations For Visit

● Take a full mouth set of xrays- patient currently having pain on the lower left and the upper right
● Discuss current habits that could be affecting the dentition
● Assess risk for developing decay
● Update perio chart
● Determine periodontal diagnosis
● Clean the teeth and set plan and goals for future cleanings
● Re-evaluated if needed
Radiographs
Dental Chart
1st Mouth Worksheet
1st Mouth Worksheet

● 46 areas of greater than 3mm pockets

● Inflammation present throughout the entire mouth
● 29 areas of bleeding present
● Posterior teeth were covered in plaque
Habits/CAMBRA
Habits:

● Currently drinking soft drinks and eating candy daily

○ Goal: Patient is currently eating candy and drinking soft drinks but is starting a diet program and will be quitting soon,
but goal is to eliminate soft drinks and candy. Intervention: Patient explained they will quit drinking with diet. I
recommended that they have diet or sugar free candy if they can. Otherwise rinsing with water or brushing after is a
great tip. Outcome: Candy and soda will be eliminated by 2 months.

CAMBRA:

● CAMBRA: patient is moderate risk related to irregular visits and broken restorations.
○ Goal: Lower cambra risk. Intervention: Recommended use of fluoridated toothpaste and mouth risk. Recommend
regular visits. Recommended the Bass method and demonstrated to patient. Patient is using interdental brushes
frequently in areas of food impaction and home care is good. Recommended that they use the interdental brushes in
all interproximal surfaces rather than just in the areas of impaction. Outcome: Patient will be lowered to low risk by
next recare.
Periodontal diagnosis

● Stage III Grade C periodontal disease

○ Inflammation is present throughout the mouth
○ Multiple 5mm + areas of CAL
○ Bleeding upon probing in all four quadrants
○ Margins are swollen
○ Tissue is smooth
Periodontal Goals, Intervention and Outcome

● GIO
○ Goal: Arrest periodontal disease and reduce inflammation and plaque. Intervention: Discussed with patient the
importance of arresting the periodontal disease and that her A1c of 9 could greatly be affecting the health of her
oral cavity. Discussed how perio can also worse the A1c. Recommended the patient come back for follow ups
every 2-3 weeks to take new pocket depths and verify that the pocket depths are not worsening and that
infection is starting to resolve. Discussed Bass brushing method and interdental brushes. Patient using
interdental brushes to remove food debris, but not using throughout the mouth. Recommended the patient
engaged the interdental brushes with the gum tissue in between all contacts. Patient understood. Outcome:
Patient will complete follow up in 3 weeks and if we have Arestin we will place at that visit to reduce infection.
Plaque will be reduced by 75% at that visit.
3 Week Follow-up

● 8 areas of <3 mm pockets

● Localized areas of inflammation
● 13 BOP areas
● Light plaque biofilm in localized areas
Changes Made by Patient

● Huge change in diet- lowered frequency of drinking soft drinks and eating candy
● Started using Peridex daily as prescribed by the dentist
● Started brushing twice daily
● Using interproximal brushes between all teeth, not just where food was getting impacted
3 Week Follow-up Perio Chart
3 Week Follow-up Mouth Worksheet
Follow-up Conclusion

● Arestin was placed in a 5 mm pocket to aid in the healing process.

● Goal of reducing plaque by 75% was met at 3 week follow up.
● Goal of lowering A1c level was achieved as patient was at 7.5 at the 3 week recare.
● Disease was beginning to be arrested with 38 pockets improving and 16 less areas of BOP.